Ivabradine or atenolol can be used for heart rate control in patients with moderate mitral stenosis in sinus rhythm. Ivabradine is not superior to atenolol for controlling heart rate or exercise capacity. Left ventricular MPI was unaffected by either of the drugs.

Hammock valve, also known as anomalous mitral arcade is a rare mechanism for congenital mitral insufficiency. We report a case of a two-week-old neonate who presented with features of heart failure and an apical systolic murmur. Echocardiogram showed severe mitral regurgitation and abnormal mitral valve with direct attachment of mitral leaflets to papillary muscle without intervening chordae tendinae, typical of hammock valve. Heart failure was controlled with ionotrpes and diuretics. The literature on the hammock mitral valve is reviewed.

Pulmonary arteriovenous malformations (AVM) are very rare and carry the risk of cerebral thrombo-embolism, brain abscess or pulmonary hemorrhage. The Amplatzer vascular plug II (AVP II) is a new device, used for embolization of the pulmonary AVMs. We report a case of pulmonary AVM successfully managed by using AVP II in a patient with hereditary hemorrhagic telangiectasia (HHT).

A 72-year-old lady presented with history of recurrent episodes of syncope. Examination revealed a mid-diastolic murmur at apex. Electrocardiogram showed left atrial enlargement. Chest X-ray was normal. Transthoracic echocardiography showed a mobile left atrial mass of mixed echogenicity (see online supplementary video 1). Transoesophageal echocardiography confirmed a 60×30 mm, broad-based, pedunculated mass arising from left atrial appendage, resembling an 'elephant's trunk' prolapsing through the mitral valve to the left ventricle during each diastole (figure 1, see online supplementary video 2). The mass was surgically excised. Histopathology was consistent with cardiac myxoma.

No abstract